Weekly subcutaneous recombinant human erythropoietin corrects anemia of progressive renal failure.

PURPOSE: The purpose of this study was to analyze data retrospectively from our use of weekly subcutaneous recombinant human erythropoietin (rHuEPO) in predialysis and peritoneal dialysis patients with anemia. PATIENTS AND METHODS: All anemic patients with progressive renal failure (12 predialysis and seven home peritoneal dialysis) in whom subcutaneous rHuEPO therapy was begun at, or was reduced to, a weekly dose were studied retrospectively. Patients were not selected for, nor excluded from, these observations for any other reason. Hematocrit and endogenous creatinine clearance were monitored regularly, and no other new treatment for anemia was given except oral iron. Iron-deficiency anemia was considered improbable because of normal red blood cell mean corpuscular volume. Unfortunately, iron parameters were not monitored. RESULTS: The hematocrit increased 4 to 9 percentage points in 4 to 13 weeks in all but two patients who were initially treated with weekly doses, and a hematocrit of 31% was achieved in these patients within 6 to 12 weeks. The mean effective dose to accomplish this was 150 U/kg. All but three patients could be maintained on weekly doses at a hematocrit of 31% or higher. The mean effective dose was 75 U/kg. CONCLUSION: It is concluded that subcutaneous rHuEPO administered weekly can correct the anemia of predialysis and peritoneal dialysis patients. Weekly dosing is more convenient for patients and may be less costly for Medicare providers.

Seldinger technique for Tenckhoff catheter placement.

The Seldinger technique can be applied to the placement of chronic peritoneal dialysis catheters. With strict adherence to criteria identifying low risk patients, the procedure is comparatively safe, simple, usually better tolerated, and likely to be less costly than laparotomy placement. Using a straight Tenckhoff catheter with a subcutaneously placed single cuff, our one year catheter survival is similar to the multicenter data reported by The National CAPD Registry.

Role of catheter removal in therapy of bacterial peritonitis of continuous ambulatory peritoneal dialysis.

Bacterial peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPD) patients usually responds within a few days to intraperitoneal antibiotics. Catheter removal is rarely needed to resolve the episodes unless they are complicated by endogenous sources such as perforated diverticulitis or infections of the extraperitoneal catheter section. Recurrent peritonitis with the same organism has been attributed to bacterial colonization of the intraperitoneal section, making the decision for catheter removal more difficult. Catheter removal with substitution of hemodialysis may have greater morbidity than prolonged antibiotics. The authors retrospectively analyzed our incidence of and reasons for catheter removal during therapy for bacterial peritonitis for the period from October 1, 1980, to December 31, 1986. For uncomplicated peritonitis, that is, in the absence of infection of the extraperitoneal catheter section, endogenous sources, and episodes associated with catheter function problems per se, the authors were able to resolve the peritonitis without catheter removal in 99.2% of cases. It was concluded that the intraperitoneal catheter section plays a negligible role in thwarting therapeutic efforts in uncomplicated bacterial peritonitis of CAPD.

Normalization of hematocrit in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis: the role of erythropoietin.

Observations were made retrospectively and prospectively over one year on all patients on continuous ambulatory peritoneal dialysis (CAPD) to determine the effect of this modality on the hematocrit. Serum erythropoietin and parathyroid hormone levels were measured. Within five months the hematocrit increased 47 to 127 percent up to normal in four of nine patients. Five others remained severely anemic. There was no significant difference in serum creatinine levels among the patients within one month of CAPD. The four patients who responded were anemic while on hemodialysis and other modalities of end-stage renal disease management prior to CAPD. The serum erythropoietin level in the four patients who responded was 9.0 mU/ml or greater with a mean of 28 mU/ml, whereas in those who did not respond it was 5.0 mU/ml or less with a mean of 3 mU/ml. Since uremic toxins in the middle molecule range have been postulated to be responsible for erythropoiesis suppression in end-stage renal disease, and in addition, insufficient erythropoietin production and the clearance of some middle molecular weight substances is six times greater with CAPD than with hemodialysis, it appears that CAPD can normalize the hematocrit in patients with end-stage renal disease who were anemic on other modalities with little or no change in serum creatinine, provided the remnant kidneys are capable of producing sufficient erythropoietin. Parathyroid hormone levels were higher in patients who responded than in patients who did not respond.

Gram-negative sepsis with acute renal failure. Occurrence from acute glomerulonephritis.

Acute intrinsic renal failure occurred in an adult patient with Escherichia coli septicemia. The clinical course did not include any of the circumstances usually present when acute renal failure complicates Gram-negative sepsis. A renal biopsy showed acute proliferative glomerulonephritis. There was no evidence to support other known causes of acute parenchymal renal failure, such as poststreptococcal glomerulonephritis, subacute bacterial endocarditis, or vasculitis. The patient recovered completely with antibiotic therapy, and renal function returned to normal within two weeks. An immunologic mechanism involving E coli was considered responsible for the acute renal failure.